Judgments in favor of a hospital, insurance company and ambulance provider were affirmed Thursday in a wrongful death suit brought by a cystic fibrosis patient’s late husband. The woman died from pneumonia after a prolonged ambulance ride toward a lung transplant that ended up at the wrong hospital.

Kimberly Snyder, who was a critically ill cystic fibrosis patient at St. Joseph Regional Medical Center, was scheduled for a lung transplant in Pennsylvania in 2013. Snyder’s insurance provider, Humana Insurance Company, denied her airfare coverage to a Pittsburgh hospital for the transplant, and SJRMC arranged for Kimberly to be transported by a Prompt Medical Transportation ambulance. She was then sedated, intubated and ventilated for the journey.

However, the Prompt team arrived at the wrong location and encountered several roadblocks in finding the correct hospital. During the prolonged trip, Kimberly’s sedation medicine ran out and her condition significantly worsened. Although at the wrong hospital, she was admitted to the intensive care unit, where doctors discovered a clot clogging her breathing tube.

Although she was returned to stable condition, Kimberly contracted pneumonia and died one week later. Kimberly’s husband, Steve Snyder, on behalf of her estate, sued Prompt, SJRMC and Humana for wrongful death.

A medical review panel concluded neither Prompt nor SJRMC had breached the standard of care. The case was reinstated three years later, but Humana’s motion to dismiss was granted. In September 2017, trial against the remaining defendants was continued to April 2019 and the expert disclosure date for the estate was set for April 12, 2018.

The estate only filed one expert witness before that date but included more witnesses’ months later that were not previously disclosed to the parties. A motion to strike the additional affidavits was granted, and the trial court ultimately awarded summary judgment to SJRMC and Prompt.

In an appeal of the trial court’s ruling, the estate argued the trial court erred in striking its additional affidavits and in its dismissal of Humana. First, the estate argued that even if its expert disclosures were untimely, the sanction of striking the affidavits was too harsh because it resulted in summary judgment being entered against it.

The Indiana Court of Appeals disagreed in Steve Snyder, as Personal Representative of the Estate of Kimberly Snyder, Deceased v. Prompt Medical Transportation, Inc.; Humana Insurance Company; and St. Joseph Regional Medical Center, 18A-CT-03112, finding that the additional experts were disclosed five months after the set deadline had passed, with no relief sought by the estate from the deadline.

It further found that the estate’s sole witness stated he could not say whether there was a “clear-cut causal relationship” between Kimberly’s instability upon arriving at the ICU or her subsequent pneumonia.

“In other words, at his deposition, Dr. Pilewski opined implicitly that SJRMC’s decision to transfer Kimberly to Pittsburgh by ambulance and explicitly that Prompt’s conduct during that ambulance ride did not, in fact, cause Kimberly’s death,” Judge John G. Baker wrote. “And while he might believe that the outcome would have been different had the disastrous ambulance ride not occurred, he conceded that any such belief is based on pure speculation.”

The panel thus concluded that the trial court properly focused on the expert’s deposition testimony rather than his affidavit with respect to causation and did not err in granting the defendants summary judgment.

Additionally, the appellate panel noted that the estate’s argument with Humana’s determination that ground transportation was not contraindicated was not negligent under Indiana law.

“Indeed, if allowed to stand, the Estate’s complaint could theoretically allow Humana to be found negligent even if it fully complied with all federal laws and regulations. Under these circumstances, we can only conclude that the Estate’s claims, which sound in state law that must be applied with respect to Medicare Part C, are pre-empted pursuant to Part C’s express preemption provision,” Baker wrote. “Therefore, the trial court did not err by granting Humana’s motion to dismiss.”